40mg propranolol daily, advice on starting citalopram again. Anxiety depression ibs

[stephenwil]

Hi everyone hope it's been an easy day so far,
Cut a long story short, Iam 24 M. Currently battling constant anxiety panic attacks. And suspected ibs. With constant sickness dizziness I also get extremely bad acid constantly stomach discomfort and pain. Sometimes to the point where I'm sick or bits of food will come back up had every scan everything to them is no sign of anything serious. Which is of course good to hear. But the symptoms I live with daily. Is getting me so down. I think this all started coming out to my parents, back in 2014. Which was insane. Everything now better. In terms of that. I have all this. I'm currently on 40mg of propananol daily which I take, somehow they settle me but I do get tired and also a little dizzy if standing, I then started citalopram which give me bad dreams like crazy bad lolol. Although I don't think I took them long enough cos I was scared a bit with the SA of them. I have now opted to stick them out, because I know the propranolol is working because if I'm late by an hour I'll be a anxious shaking mess. So need citalopram for the mental side really. Cos I'm only now really realising that prop is more physical symptoms. I'm just anxious at taking them again when best to take them, I just remember the time I had when first starting and that alone makes it worse. Anyone in a similar situation or have took these before would be helpful with all this. Thanks for any suggestions. Stephen

[panic_down_under]

Hi everyone

Welcome to No More Panic

I'm currently on 40mg of propananol daily which I take, somehow they settle me but I do get tired and also a little dizzy if standing

...I know the propranolol is working because if I'm late by an hour I'll be a anxious shaking mess.

...Cos I'm only now really realising that prop is more physical symptoms.

The fact you dissolve into an "anxious shaking mess" if you're late taking propranolol doesn't necessarily mean it is working. Those symptoms may be from withdrawal, not from uncontrolled anxiety.

The beta-blockers have no direct affect on anxiety in the way antidepressants and benzodiazepines do. All they do is ease the adrenaline fuelled symptoms of the flight-or-flight response. For milder anxiety this may often be enough.

So need citalopram for the mental side really.

An antidepressant would be a better long-term bet, but I'm not convinced SSRIs, SNRIs and serotonergic TCAs would be your best option given your GI tract issues. The enteric nervous system (ENS), the mini brain which controls the gut (and via the vagus nerves also influences the brain, heart and lungs to varying degrees) is by far the most serotonergic organ of the body making and using about 50 times as much serotonin as the brain so it is often more affected adversely by serotonergic antidepressants than the brain is, and this can be even more the case when there are preexisting GI problems.

That said, they improve both GI issues and anxiety often enough that they can't be totally excluded, however, I believe antidepressants which primarily inhibit noradrenaline, aka norepinephrine, reuptake such as the TCAs nortriptyline (Pamelor) and desipramine (Norpramin) should be the first choice for those with IBS etc.

The SNRIs milnacipran (Savella) and levomilnacipran (Fetzima) also are strong NE reuptake inhibitors, but I don't know if they are used much in the UK. Not that it matter as, imho, nortriptyline is the better med.

[stephenwil]

Thanks for your detailed reply I will have to look into it a bit more, and will speak to my doctor, it's not just the anxiety, is the constant stomach and bowel problems I have and never did I think is be dealing or feeling this way, it seems I'm in a vicious circle the moment, I have never heard of the other antidepressants. Or meds. That's all I have at the moment for my stomach etc is omeprazole. I think the anxiety spikes. and I just feel like rubbish. With them pointing to stress as the main cause how come there's nausea almost constantly acid regurgitation stomach is never settled, but I'm to this point reassured nothing physical is going on. But I'm not sure it feels like something is wrong. Physically. And not just stress. Unless I got to tell myself maybe it is all anxiety. Sometimes I feel as if I'm going mad, I think I subconsciously worry also a lot of the time. I'm just really stuck..

Thanks for reply good info keep well.

---------- Post added at 13:43 ---------- Previous post was at 12:08 ----------

Withdrawal from what the propranolol? I been taking it, 40"mg once a day as required, I wonder if they are wearing of after a few hours but surly 40mg is a lot for anxiety is it?

[panic_down_under]

I been taking it, 40"mg once a day as required, I wonder if they are wearing of after a few hours but surly 40mg is a lot for anxiety is it?

2 x 40mg is a common starting dose for the immediate-release formulation, or 1 x 80mg for the slow-release. Propranolol has a short half-life of around 3-4 hours, but it does have an active metabolite which has a slightly longer half-life of 5-7 hours.